Matilda Denise Kelley, BSN, RN, CLT
Individual provider Active NPI Registered Nurse · Vidor, TX
NPI 1194503391 · NPPES record last updated Sep 24, 2024
Key facts
- NPI
- 1194503391
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 769373 (TX)
- Practice address
- 2750 Highway 12
Vidor, TX 77662-3435 - Phone
- (409) 659-7306
- Fax
- (409) 422-0050
- NPI assigned
- Sep 19, 2023
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Bachelor on Science - Nursing, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 769373 | TX | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kelley'S Karing Touch, LLC | Current |
Accepting new patients | |
| Lymphatic & Massage Studio of Barbara White | Past |
Accepting new patients |
Locations
2750 Highway 12
Vidor, TX 77662
Phone (409) 201-5293
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 769373 | TX | Yes |
Addresses
Primary practice location
2750 Highway 12
Vidor, TX 77662-3435
Mailing address
2699 Marion St
Vidor, TX 77662-8192
Phone (409) 201-5293
Other providers in Vidor, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 24, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.